All-arthroscopic reduction and fixation of Pipkin type <b>Ⅰ</b> and <b>Ⅱ</b> femoral head fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Lü Jiahao , WANG Hua , CHEN Liaobin ,  NI Qubo

Department of Joint and Sports Medicine, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P. R. China;

Corresponding?author：

NI Qubo, Email: niqubo@163.com

Keywords：

Femoral head fractures; arthroscopy technique; Pipkin classification; bioabsorbable screws; minimally invasive surgery

DOI：

10.7507/1002-1892.202601132

Video：

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Objective To investigate the effectiveness of all-arthroscopic treatment for Pipkin type Ⅰ and Ⅱ femoral head fractures. Methods A retrospective analysis was conducted on the clinical data of 13 patients with Pipkin type Ⅰ and Ⅱ femoral head fractures who underwent all-arthroscopic reduction and fixation between May 2015 and May 2024. The cohort included 10 males and 3 females, with an average age of 27.4 years (range, 14-40 years). The mechanisms of injury involved traffic accidents in 11 cases and falls from a height in 2 cases. According to the Pipkin classification, there were 7 type Ⅰ and 6 type Ⅱ fractures. Seven patients presented with concomitant posterior hip dislocation. The interval from injury to surgery ranged from 1 to 10 days, averaging 3.2 days. Fixation was achieved using bioabsorbable suture anchors in 7 cases, bioabsorbable screws in 4 cases, and Herbert screws in 2 cases. Key parameters including operation time, intraoperative blood loss, complications, and fracture healing time were recorded. At last follow-up, hip joint function was evaluated using the Harris hip score and the Thompson-Epstein evaluation criteria. Results The operation time ranged from 100 to 140 minutes, with an average of 119.5 minutes. The intraoperative blood loss ranged from 20 to 65 mL, with an average of 40.8 mL. No postoperative complication such as neurovascular injuries occurred, and all incisions healed by primary intention. All 13 patients were successfully followed up 9-24 months, with an average of 16 months. The fracture healing time ranged from 10 to 18 weeks, averaging 14.1 weeks. During the follow-up, no complication such as traumatic osteoarthritis, osteonecrosis of the femoral head, heterotopic ossification, or internal fixation failure was observed. At last follow-up, the Harris hip score ranged from 91 to 97, averaging 94.6. Based on the Thompson-Epstein criteria, the clinical outcomes were graded as excellent in 9 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion For Pipkin type Ⅰ and Ⅱ femoral head fractures, all-arthroscopic fixation represents a safe and effective therapeutic strategy. The individualized selection of Herbert screws, bioabsorbable screws, or suture anchors based on the specific characteristics of the fracture fragments offers significant clinical advantages. This approach ensures minimal invasiveness, minimal disruption of the femoral head blood supply, and a low complication rate.

Citation： Lü Jiahao, WANG Hua, CHEN Liaobin, NI Qubo. All-arthroscopic reduction and fixation of Pipkin type Ⅰ and Ⅱ femoral head fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(6): 906-911. doi: 10.7507/1002-1892.202601132 Copy

1.	Regenbogen S, Watrinet J, Beck M, et al. Treatment and clinical outcome in patients with femoral head fractures: a long-term follow-up. Arch Orthop Trauma Surg, 2024, 144(9): 4491-4497.
2.	Droll KP, Broekhuyse H, O’Brien P. Fracture of the femoral head. J Am Acad Orthop Surg, 2007, 15(12): 716-727.
3.	Stannard JP, Harris HW, Volgas DA, et al. Functional outcome of patients with femoral head fractures associated with hip dislocations. Clin Orthop Relat Res, 2000(377): 44-56.
4.	Schaffer NE, Luther L, Tatman LM, et al. Femoral head fractures: evaluation, management, and outcomes. J Am Acad Orthop Surg, 2024, 32(20): 929-937.
5.	Yin XY, Liu Y, Liu WG, et al. Arthroscopic fixation with absorbable suture anchors for Pipkin type Ⅰ femoral head fractures: letter V technique. Arthrosc Tech, 2024, 13(10): 103090. doi: 10.1016/j.eats.2024.103090.
6.	Hart A, Harvey EJ, Lefebvre LP, et al. Insertion profiles of 4 headless compression screws. J Hand Surg (Am), 2013, 38(9): 1728-1734.
7.	Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg (Am), 1951, 33(3): 746-748.
8.	高悠水, 孫玉強, 張長青. 股骨頭骨折的診治進展. 中華骨科雜志, 2016, 36(6): 361-369.
9.	Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12): 1245-1251.
10.	Hougaard K, Thomsen PB. Traumatic posterior dislocation of the hip: prognostic factors influencing the incidence of avascular necrosis of the femoral head. Arch Orthop Trauma Surg, 1986, 106(1): 32-35.
11.	杜遠立, 章世平, 鄧桂, 等. 可吸收螺釘在青壯年股骨頭骨折手術中的應用. 生物骨科材料與臨床研究, 2015, 12(1): 30-32.
12.	Sahin V, Karaka? ES, Aksu S, et al. Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. J Trauma, 2003, 54(3): 520-529.
13.	叢嶺, 孫香偉, 閆海明. 髖關節后脫位合并股骨頭骨折11例治療體會. 中國實用醫藥, 2010, 5(13): 181.
14.	辛茂源, 劉振, 高加智, 等. 關節鏡復位固定Pipkin Ⅰ和Ⅱ型股骨頭骨折. 中國矯形外科雜志, 2025, 33(17): 1609-1613.
15.	Aprato A, Caruso R, Reboli M, et al. Arthroscopic reduction and fixation of a Pipkin Type-I femoral head fracture. JBJS Essent Surg Tech, 2024, 14(2): e23.00073. doi: 10.2106/JBJS.ST.23.00073.
16.	胡聯英, 賈其余, 俞宇, 等. Herbert螺釘治療Pipkin骨折的臨床療效分析. 中國骨傷, 2016, 29(2): 162-166.
17.	林偉文, 賴茂松, 熊浩, 等. 可吸收釘棒治療Pipkin Ⅰ、Ⅱ型股骨頭骨折15例臨床觀察. 重慶醫學, 2014, 43(19): 2493-2494.

1. Regenbogen S, Watrinet J, Beck M, et al. Treatment and clinical outcome in patients with femoral head fractures: a long-term follow-up. Arch Orthop Trauma Surg, 2024, 144(9): 4491-4497.
2. Droll KP, Broekhuyse H, O’Brien P. Fracture of the femoral head. J Am Acad Orthop Surg, 2007, 15(12): 716-727.
3. Stannard JP, Harris HW, Volgas DA, et al. Functional outcome of patients with femoral head fractures associated with hip dislocations. Clin Orthop Relat Res, 2000(377): 44-56.
4. Schaffer NE, Luther L, Tatman LM, et al. Femoral head fractures: evaluation, management, and outcomes. J Am Acad Orthop Surg, 2024, 32(20): 929-937.
5. Yin XY, Liu Y, Liu WG, et al. Arthroscopic fixation with absorbable suture anchors for Pipkin type Ⅰ femoral head fractures: letter V technique. Arthrosc Tech, 2024, 13(10): 103090. doi: 10.1016/j.eats.2024.103090.
6. Hart A, Harvey EJ, Lefebvre LP, et al. Insertion profiles of 4 headless compression screws. J Hand Surg (Am), 2013, 38(9): 1728-1734.
7. Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg (Am), 1951, 33(3): 746-748.
8. 高悠水, 孫玉強, 張長青. 股骨頭骨折的診治進展. 中華骨科雜志, 2016, 36(6): 361-369.
9. Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12): 1245-1251.
10. Hougaard K, Thomsen PB. Traumatic posterior dislocation of the hip: prognostic factors influencing the incidence of avascular necrosis of the femoral head. Arch Orthop Trauma Surg, 1986, 106(1): 32-35.
11. 杜遠立, 章世平, 鄧桂, 等. 可吸收螺釘在青壯年股骨頭骨折手術中的應用. 生物骨科材料與臨床研究, 2015, 12(1): 30-32.
12. Sahin V, Karaka? ES, Aksu S, et al. Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. J Trauma, 2003, 54(3): 520-529.
13. 叢嶺, 孫香偉, 閆海明. 髖關節后脫位合并股骨頭骨折11例治療體會. 中國實用醫藥, 2010, 5(13): 181.
14. 辛茂源, 劉振, 高加智, 等. 關節鏡復位固定Pipkin Ⅰ和Ⅱ型股骨頭骨折. 中國矯形外科雜志, 2025, 33(17): 1609-1613.
15. Aprato A, Caruso R, Reboli M, et al. Arthroscopic reduction and fixation of a Pipkin Type-I femoral head fracture. JBJS Essent Surg Tech, 2024, 14(2): e23.00073. doi: 10.2106/JBJS.ST.23.00073.
16. 胡聯英, 賈其余, 俞宇, 等. Herbert螺釘治療Pipkin骨折的臨床療效分析. 中國骨傷, 2016, 29(2): 162-166.
17. 林偉文, 賴茂松, 熊浩, 等. 可吸收釘棒治療Pipkin Ⅰ、Ⅱ型股骨頭骨折15例臨床觀察. 重慶醫學, 2014, 43(19): 2493-2494.

Chinese Journal of Reparative and Reconstructive Surgery

All-arthroscopic reduction and fixation of Pipkin type Ⅰ and Ⅱ femoral head fractures

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